Active NPI
Jennifer M Evans, LCSW
- Clinical Social Worker
- Mount Airy, NC
National Provider Identifier
1801192778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C008954
- Practice address
- 847 W Lake Dr
Mount Airy, NC 27030-2157 - Phone
- (336) 783-6919
- Fax
- (336) 783-6923
- NPI assigned
- Feb 9, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C008954 | NC | Primary |
Addresses
Primary practice location
847 W Lake Dr
Mount Airy, NC 27030-2157
Mailing address
284 Executive Park Dr.
Ste 100
Concord, NC 28025-1833
Phone (704) 939-1100
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326440066 | Other | NC | UNITED BEHAVIORAL HEALTH |
| 19LHL | Other | NC | BCBS |
| 601121-053 | Other | NC | MAGELLAN |
| 1326440066 | Medicaid | NC | |
| 1326440066 | Other | NC | HUMANA |
| Q48420A | Other | NC | MEDICARE |
Other names 1
- Jennifer M Desforges
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1801192778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "284 EXECUTIVE PARK DR.",
"address_2": "STE 100",
"city": "CONCORD",
"state": "NC",
"postal_code": "280251833",
"telephone_number": "704-939-1100",
"fax_number": "704-939-1173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "847 W LAKE DR",
"city": "MOUNT AIRY",
"state": "NC",
"postal_code": "270302157",
"telephone_number": "336-783-6919",
"fax_number": "336-783-6923"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "JENNIFER",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-09",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C008954",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "1326440066",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "19LHL",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "601121-053",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1326440066",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "1326440066",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "Q48420A",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "DESFORGES",
"middle_name": "M",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Mount Airy, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.